Investigation of postoperative erectile dysfunction in colorectal surgery patients and comparison of results.

BACKGROUND: Although surgical treatment is curative for colorectal cancers, erectile dysfunction (ED) is one of the complications that affect the patient quality of life. The present study aimed to evaluate sexual dysfunction in patients who underwent anterior resection (AR) and low AR (LAR) surgery secondary to rectosigmoid pathologies in our clinic, to analyze the effective variables, and to compare the results. METHODS: In the retrospectively designed study, male patients who underwent surgery for malignancy or other surgical pathologies in the General Surgery Clinic between January 2017 and December 2022 were examined. Female gender, patients under 18 years of age, and patients who refused to participate in the study were excluded. RESULTS: The high age of the patient increased the risk of severe ED in the postoperative period. However, surgical technique, alcohol use, American Society of Anesthesiologists (ASA) score, and Clavien-Dindo class were not determinants in the presence of severe ED. CONCLUSION: ED is an emerging medical problem that affects patients who undergo colorectal surgery adversely both in social and psychological aspects. Discussions on the issue are still ongoing. Clinicians' concerns can be addressed in the future as the number of prospectively designed studies involving more homogeneous and larger populations increases.

Investigation of factors that may potentially affect anxiety in patients undergoing esophagogastroduodenoscopy and evaluation of sedation effect.

BACKGROUND: As with any other invasive procedure, esophagogastroduodenoscopy (EGD) may lead to considerable anxiety in patients. This study aimed to investigate and compare the effects of sedated and non-sedated procedures on anxiety in patients undergoing EGD and to better recognize patient groups at risk for anxiety. METHODS: In this prospective and 2-armed designed study, demographic data, including age, gender, comorbidities, height, weight, body mass index (BMI), and educational background, were collected. In this study, the Beck Anxiety Inventory (BAI) was administered to each patient before they were brought to the endoscopy unit. Subsequently, each patient who underwent EGD was telephoned on the seventh day after the procedure and the BAI was administered a second time. RESULTS: Women population had higher pre-EGD and post-EGD BAI scores compared to men. No significant correlation was observed between educational background and BAI scores. Possible correlations between age, BMI, Charlson comorbidity index (CCI), and BAI scores were examined. There was a weak correlation between BMI and pre-EGD and post-EGD BAI scores. A strong and positive correlation was observed between the pre-EGD BAI score and post-EGD BAI and difference in BAI scores between groups (ΔBAI). CONCLUSION: Endoscopic procedures may cause anxiety in patients as with all other invasive procedures. Patients' compliance with the procedure and having a lower level of anxiety are very significant for diagnostic and, if necessary, therapeutic success. In this study, the patient gender was evaluated as a predictor of anxiety level, whereas educational background was not a predictor.

Non-malignant left colon emergency surgery: evaluation of factors affecting clinical outcomes and complications.

BACKGROUND: Emergency colorectal resections hold a significant position in general surgical practice, and pathologies of the left colon are relatively common. This study was conducted to assess the outcomes of isolated left colon surgeries with benign etiologies, drawing on clinicopathological and biochemical data. METHODS: We carried out a retrospective review and statistical analysis of demographic, clinical, and laboratory data of patients who underwent left colon surgery at the general surgery clinic of a tertiary care hospital, excluding those with malignancy-related emergencies, from January 2017 to January 2022. RESULTS: The average age of the 48 patients in the study was 56.9±16.4 years. Complicated acute diverticulitis was the most frequent indication for emergency surgery (n=19, 39.6%). The Hartmann procedure was the surgical technique most often employed (n=30, 62.5%). The rates of postoperative morbidity and mortality within 30 days were 27.1% and 8.3%, respectively. Increased postoperative morbidity was linked to advanced age (mean 65.4±15.8 vs. 53.8±15.7, p=0.028), the preoperative administration of vasopressors, lower platelet counts, hypoalbuminemia (<3 mg/dl), and azotemia (blood urea nitrogen >20 mg/dl). There was no statistically significant correlation between comorbidities, American Society of Anesthesiologists (ASA) scores, surgical methods, or other clinical data and postoperative outcomes. CONCLUSION: For emergency colorectal surgery pertaining to left colon pathologies, it is critical to conduct a comprehensive evaluation in the perioperative period, especially for elderly and hypotensive patients with renal function abnormalities and for those requiring vasopressors.

Fournier's Gangrene: Evaluation of Patient Outcomes Using Clinical Data and Prognostic Biomarkers.

OBJECTIVE: To find out the outcomes of Fournier's gangrene (FG) patients using clinical data and prognostic biomarkers based on the current literature. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of General Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey, from January 2018, to January 2022. METHODOLOGY: Patients who were diagnosed with and treated for FG were included in the study. Patients younger than 18 years of age, those with missing hospital records and postoperative follow-up data, those with benign diseases related to the perianal or anal region, and those with other malignant diseases were excluded from the study. Patients' demographic, clinical, and laboratory data, including the calculated systemic immune-inflammation index (SII) and pan-immune-inflammation values (PIV) were obtained retrospectively from the medical records. Variables were analysed using SPSS statistics software, version 25.0. The value of p <0.05 was considered statistically significant. RESULTS: A total of twenty-four patients, 14 (58.3%) males and 10 (41.7%) females, were included in this study. No statistically significant correlations were found between the calculated indices and patients' clinical outcomes. The length of intensive care unit stay was strongly and positively correlated with age (r = 0.672 and p <0.001), and the length of hospital stay was moderately and inversely correlated with preoperative albumin levels (r = -0.584 and p = 0.003). CONCLUSION: SII and PIV had no statistically significant interactions with FG. KEY WORDS: Fournier's gangrene, Systemic immune-inflammation index, Pan-immune-inflammation value, Colostomy, Albumin.

Evaluation and clinical significance of predictors for strangulation and intestinal resection in emergency anterior abdominal wall hernia surgery.

BACKGROUND: Emergency anterior abdominal wall hernia surgery plays a pivotal role in emergency general surgery practice. In this study, the predictive value of laboratory and imaging findings as well as demographic information and comorbidities of the patients for the recognition of strangulation and intestinal resection was investigated. METHODS: Patients over the age of 18 who were operated consecutively with an indication for emergency anterior abdominal wall hernia surgery between January 2017 and December 2019 in a single tertiary hospital were included in this retrospective cohort study. The patient population was divided into two groups according to the pre-operative findings during the emergency anterior abdominal wall hernia surgery. Group 1 consisted of cases with incarceration but without strangulation, whereas Group 2 consisted of cases with strangulation in addition to incarceration. Moreover, in evaluation for the requirement for intestinal resection, patient Group 2 was divided further into two groups, namely, as Group (1 or 2) a and Group (1 or 2) b, defining the need for intestinal resection. RESULTS: A total of 106 patients who had emergency anterior abdominal wall repair surgery due to incarcerated hernias were included in the study. The evaluation of the indices related to systemic inflammation revealed that lactate dehydrogenase to white blood cell ratio was significantly lower but neutrophil to platelet and neutrophil to albumin ratios were significantly higher in patients with strangulation, showing the significance of those systemic inflammation indices in detecting strangulation (p=0.027, p=0.035 and p=0.030, respectively). Moreover, the analysis of the patients in whom intestinal resection was required (Group 2a vs. 2b) exposed that neutrophil to albumin ratio was significantly higher in the patients with intestinal resection (p=0.036). CONCLUSION: Indices of systemic inflammation such as lactate dehydrogenase to white blood cell ratio, neutrophil to platelet ratio, and particularly neutrophil to albumin ratio may be potentially beneficial to prevent complications and improve clinical outcomes in emergency hernia surgery.

A rare case of pantaloon hernia accompanied by strangulated ileal segment: Inguinal herniation of the bladder.

Mesanenin inguinal kanal içine herniasyonu nadir görülen bir klinik antitedir ve tüm inguinal hernilerin yaklasik %1-4'ünü olusturmaktadir. Genellikle yasli erkek hastalarda ve sag tarafta sik görülmektedir. Hastalar çogunlukla asemptomatik oldugundan, intraoperatif olarak tani almaktadir. Preoperatif süreçte taninin dogrulanmasi, olasi mesane yaralanmalarinin önüne geçebilmek adina önem teskil etmektedir. Biz de bu çalismamizda; akut mekanik intestinal obstrüksiyon ve strangülasyon semptomlariyla acil servise basvuran hastada, mesane herniasyonunun eslik ettigi nadir bir pantolon herni olgusunu literatür esliginde sunmayi amaçladik.

Acute appendicitis over the age of 50: The evaluation of the impact of clinical variables on operative and post-operative outcomes.

BACKGROUND: Studies reported higher mortality and perforation rates, marked increase in delay from symptom onset to hospital admission, significant complication rates, as well as excessive malignancy outcomes on histopathological examinations in patients older than 50 years of age with acute appendicitis. Herein, it was aimed to reveal the clinical, laboratory, and imaging findings that might affect the operative and post-operative findings in a population of patients over the age of 50 who were diagnosed with and operated for acute appendicitis. METHODS: Patients who were older than 50 years of age and operated for the diagnosis acute appendicitis between January 2017 and January 2020 in a single tertiary hospital were included in this retrospective study. Demographic data, comorbidities, laboratory and imaging findings, operative and post-operative results, surgical complications, as well as the histopathological evaluation of the excised materials of all patients were analyzed in detail. RESULTS: A total of 152 patients who were older than 50 years of age and who underwent emergent appendectomy with a median age of 59 were included in the study. It was demonstrated that the development of surgical complications was significantly associated with post-operative hospitalization at the intensive care unit (ICU) and the presence of 2 or more comorbidities preoperatively (p=0.006 and p=0.002, respectively). It was observed that the duration of total hospitalization was longer (p<0.001), pre-operative al-bumin levels were lower (p=0.017), and the rate of hospitalization at ICU during the follow-up period was higher (p=0.006) in patients with surgical complications. Pre-operative white blood cell counts appeared to be significantly increases in patients who had open appendectomy (p=0.047). Moreover, both the duration of pre-operative abdominal pain and pre-operative C-reactive protein levels was found to significantly correlate with the duration of hospitalization (p<0.001 and p<0.001, respectively). CONCLUSION: The management of acute appendicitis in late adulthood was suggested to be challenging both in terms of diagnosis and post-operative processes. Therefore, pre-operative clinical, laboratory, and imaging data obtained from these patients should be carefully and elaborately evaluated.

Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumours: Our Clinical Experience and Results.

Upper gastrointestinal subepithelial tumours (SETs) are generally asymptomatic and clinically insignificant and have malign, borderline and benign variants. In advanced endoscopic procedures, histopathological diagnosis and endoscopic resection are possible and feasible. In this study, we examined our approach to upper gastrointestinal subepithelial tumours and our clinical results. Adult patients who applied to Surgical Endoscopy unit between January 2014 and January 2015 were included in the study. The patients' files and final histopathological diagnoses were recorded and analysed retrospectively for this single-center study. SET lesion lower than 30 mm and the lesion whose endoscopic submucosal dissection attemption was included in the study. The total of 8 patients were four female (50%) and four male (50%), aged 31-66 years (median, 53 years). The tumoral lesions were located 4 (50%) patients in esophagus, 3 (37.5%) patients in stomach and one (12.5%) patient in duodenum and their diameter ranged from 5 to 30 mm (median, 14 mm). Post-interventional no complications or abdominal symptoms were encountered. Also, in early follow-ups for six months, no recurrence was observed. Our experiences together with literature reported here, indicated endoscopic resection is a safe and effective method of treatment for most patients with upper gastrointestinal SETs.

An Extraordinary Case of Isolated Duodenal Injury after Blunt Abdominal Trauma.

Duodenal injuries are rare due to their preserved retroperitoneal location. They are mostly observed after deep penetration or high-impact blunt trauma. They are difficult to diagnose and treat. Our purpose was to report a case of duodenal injury after blunt trauma with the review of the literature. A 20-year male patient was brought to Emergency Department with abdominal pain after an accident, in which he was stuck between a reversing truck and a pole. Rigidity in all abdominal quadrants was detected. Free pelvic fluid was observed in computed tomography (CT). There was a grade II laceration at the fourth part of the duodenum. The laceration was primarily sutured, and a naso-jejunal tube was placed. The patient was discharged on postoperative day-8 with uneventful recovery. In suspicion of duodenal trauma, a meticulous anamnesis, careful physical examination, proper imaging technique at appropriate timing, and surgical exploration are important to reduce morbidity and mortality. Imaging findings of retroperitoneal organ injuries can be non-specific. We suggest that surgical exploration should be the first choice of treatment in cases with acute abdomen findings. Key Words: Blunt trauma, Acute abdomen, Duodenum, Retroperitoneum.

Comparison of outcomes of the patients with acute cholecystitis treated in the COVID-19 pandemic and pre-pandemic period.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has affected the health care system in an unpredictable way. In this study, we aimed to analyze the effects of the pandemic process on the disease severity on admission, management strategies, and outcomes of patients. METHODS: The medical records of the patients who applied to the emergency department and consulted to the general surgery clinic from March 2020 until January 2021 were retrospectively reviewed as the pandemic period. For the control group, patients' medical records in the same time interval of 2019 were evaluated as the pre-pandemic period. RESULTS: A total of 88 patients in the pre-pandemic period and 89 patients in the pandemic period were treated for acute cholecystitis. There was no statistically significant difference between the two groups in terms of the treatment strategies and length of hospital stay between the two periods (p=0.087 and p=0.587, respectively). CONCLUSIONS: In the pandemic period, it is thought that postponing and bridging treatments may replace surgery for reducing the risk of contamination of both patients and health care workers.

A rare case of acute mechanical intestinal obstruction: Colonic endometriosis.

Endometriosis is a disease seen in women at reproductive age, characterized by extrauterine localization of endometrial tissue. Colonic endometriosis rarely causes acute mechanical intestinal obstruction (AMIO). It may also be presented with pelvic pain, dyspareunia, tenesmus, painful defecation related to the menstrual cycle. In the literature, 3-37% of the gastrointestinal location was reported and AMIO was observed in 7-23% of these cases. There are only few cases of mechanical obstruction related to sigmoid endometriosis mimicking colon malignancy. In this study, we aim to report a case of a 40-year-old patient with AMIO developed secondary to colonic endometriosis in light of the literature. The patient was discharged with full surgical recovery after the Hartmann procedure was performed, and the pathological diagnosis was reached as endometriosis. At the post-operative sixth-month colostomy, closure and bilateral oophorectomy were performed with the patient's will. The patient was discharged with surgical recovery and is still being regularly followed up. Endometriosis is a gynecological disease that may occur in all organ systems even though the most common location is the overs. Gastrointestinal located endometriosis should, therefore, be kept in mind in the etiology of AMIO in women at reproductive age and the related symptoms should be questioned in differential diagnosis.

Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy.

OBJECTIVE: The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia. METHODS: Patients who underwent thyroidectomy at Istanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who were found to have hypocalcemia (calcium ≤8.5 mg/dL) according to postoperative serum level and normocalcemic patients were placed in Group 2. Groups were compared statistically in terms of rate of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism. RESULTS: Mean age was 49.8±12.8 years (range: 20-88). A total of 417 patients were included in the study, 74 (17.7%) were male and 343 (82.3%) were female. Group 1 consisted of 205 (49.2%) patients who had hypocalcemia according to postoperative serum level, and remaining 212 (50.8%) patients were placed in Group 2. In Group 1, 38 (18.5%) patients had incidental parathyroidectomy, and with only 18 (8.5%) patients in Group 2, a statistically significant relationship was found between incidental parathyroidectomy and hypocalcemia (p=0.003). There was no statistically significant difference in terms of presence of thyroiditis or hyperthyroidism between groups. There was statistically significant decrease in postoperative hypocalcemia rate in patients with lobectomy compared to patients with bilateral total thyroidectomy or central neck dissection (p<0.01). CONCLUSION: Risk of postoperative hypocalcemia may be reduced with lobectomy for selected patients. In addition, delicate dissection during thyroidectomy is important in order to protect parathyroid glands and prevent hypocalcemia.

Agenesis of the gallbladder diagnosed by magnetic resonance cholangiography: report of a case and review of the literature.

Gallbladder agenesis (GA) is a rare congenital anomaly of the biliary system often associated with other congenital abnormalities. Patients become symptomatic in 23% of cases (Richards et al., 1993). GA is often misinterpreted as other diseases, therefore, leading to unnecessary surgery. Many of these patients develop a typical symptomatology of cholelithiasis that leads them to operating theatre. If an operative procedure is done, it is better to remain at the level of laparoscopy because further surgical investigation may lead to detrimental biliary tract injuries (Waisberg et al., 2002). We present a case of GA, diagnosed by magnetic resonance with cholangiopancreatography.